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Senna

SCIENTIFIC NAME(S): Cassia acutifolia Delile, syn. with Cassia senna L. and C.angustifolia Vahl. Family: Fabaceae

Senna (Cassia angustifolia) is a small shrub that grows in regions of the upper Nile of North Africa and Arabia. The ancient Egyptian doctors used senna over 3500 years ago for their royal patients and the elite. It was also used by the Arabian physicians as far back 9th century A.D. After being introduced to Europe during the Crusades, its popularity as an herbal remedy exploded. While available as single product, senna is often combined with a variety of aromatic herbs.

History

Senna was first used medicinally by Arabian physicians in the ninth century AD.It was used in traditional Arabic and European medicine as a cathartic.The leaves have been brewed and the tea administered tor its strong laxative effect. Because it is often difficult to control the concentration of the active ingredients in the tea, an unpredictable effect may be obtained. Therefore, standardized commercial dosage forms have been developed, and these concentrates are available as liquids, powders, and tablets in otc laxatives. The plant derives its name from the Arabic "sena" and from the Hebrew word "cassia," which means "peeled back," a reference to its peelable bark.

Botany :- C. acutifolia is native to Egypt and the Sudan while C. angustifolia is native to Somalia and Arabia. Plants known as "wild sennas" (C.hebecarpa Fern. and C. marilandica L.) grow on moist banks and woods in the eastern US . Do not confuse this plant with "cassia," a common name for cinnamon. Senna is a low branching shrub, growing to about 0.9 m in height. It has a straight woody stem and yellow flowers.The top parts are harvested, dried, and graded. The hand-collected senna is known as Tinnevally senna. Leaves that have been harvested and graded mechanically are known as Algraded senna. There are more than 400 known species of Cassia.

Uses of Senna

Senna is most commonly used as a laxative.

Side Effects of Senna

The chronic use of senna has resulted in pigmentation of the colon,reversible finger clubbing, cachexia, and a dependency on the laxative.

Dosage

People using over-the-counter senna products should carefully follow label instructions. An extract in capsules or tablets providing 20-60 mg of sennosides per day is sometimes recommended. This can be continued for a maximum of ten days. Use beyond ten days is strongly discouraged. If constipation is not alleviated within ten days, people should seek the help of a healthcare professional.

Toxicology

Chronic use of any laxative,in particular irritant laxatives such as senna, often results in a Iaxativedependency syndrome" characterized by poor gastric motility in the absence of repeated laxative administration. Other reports of laxative abuse include laxative induced diarrhea, osteomalacia, and arthropathy associated with prolonged use.

The chronic use of anthroquinone glycosides has been associated with pigmentation of the colon (Melanosis coli). Several cases of reversible finger clubbing (enlargement of the ends of the fingers and toes) have been reported following long-term abuse of senna­containing laxatives.One report described a woman who developed finger clubbing following ingestion of 4 to 40 Senokot tablets per day for about 15 years. Clubbing reversed when the laxative was stopped. The mechanism may be related to either increased vascularity of the nail beds or a systemic metabolic abnormality secondary to chronic laxative ingestion.

Senna abuse has been associated with the development of cachexia and reduced serum globulin levels after chronic ingestion.

Risk assessment for senna's use during pregnancy has been addressed.One review suggests senna to be the "stimulant laxative" of choice during pregnancy and lactation.None of the breastfed infants experienced abnormal stool consistency from their mothers' ingestion of senna laxatives. The constituent rhein, taken from milk samples varied in concentration from 0 to 27 ng/mL with 89% to 94% of values less than 10 ng/mL. Non-standardized laxative are not recommended during pregnancy.

Generally, senna may cause mild abdominal discomfort such as cramping Prolonged use may alter electrolytes. Patients with intestinal obstruction should avoid senna.

Various case reports of senna toxicity are available and include coma and neuropathy after ingestion of a senna combination laxative,hepatitis after chronic use of the plant,occupational asthma and rhinoconjunctivitis from a factory worker exposed to senna-containing hair dyes, and asthma and allergy symptoms from workers in bulk laxative manufacturing facility.

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